Skin dressings

ABSTRACT

A skin dressing comprises a hydrated hydrogel material including a source of lactate ions and a supply of glucose, optionally also including a source of zinc ions and a source of iodide ions. The dressing has beneficial effects on skin.

This application is a continuation-in-part of PCT/GB2004/002374 filedJun. 4, 2004 and claims priority benefit of that application as well asthe benefit of GB Application No. 0303217.2 filed Jun. 9, 2003; EPApplication No. 04250508.1 filed Jan. 30, 2004; and GB Application No.0427444.5 filed Dec. 15, 2004, the contents of each of said earlierapplications being incorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to skin dressings for application to a part of ahuman or animal body for treatment of skin (for therapeutic or cosmeticpurposes), and relates particularly (but not exclusively) to wounddressings for treatment of compromised skin, particularly skin lesions,i.e. any interruption in the surface of the skin, whether caused byinjury or disease, including skin ulcers, burns, cuts, punctures,lacerations, blunt traumas, acne lesions, boils etc.

BACKGROUND OF THE INVENTION

Skin and wound dressings are designed to undertake a number of importantfunctions to aid the process of healing. Experts agree on most of thefunctions that an ideal dressing should provide, and these include:

-   -   Donation of moisture to dry wounds    -   Absorption of excess fluid from weeping wounds    -   Maintenance of a moist environment around the wound bed    -   Binding of water sufficiently well to prevent maceration        (water-logging) of the normal tissue    -   Aiding debridement (removal of dead tissue and scar material)    -   Prevention of infection and provision of a barrier to escaping        or invading microbes    -   Killing infecting microbes    -   Cushioning against further physical trauma    -   Maintaining an optimum temperature through thermal insulation    -   Allowing ingress of plentiful oxygen    -   Soothing painful and inflamed open wound sites    -   Flexibly adapting to the shape of the wound site    -   Keeping its physical integrity so that fragmented dressing        debris is not left in the wound    -   Exerting no cytotoxic nor physically damaging effects on the        healing cells.

In addition, the handling and physical design characteristics shouldmake the dressing easy to use and comfortable to wear. For storage anddistribution purposes, the dressing should be stable at ambienttemperatures, and robust. Ideally it should be simple to manufacture, inorder to allow its production and sale at a price that is affordable forwidespread use.

These and other demands make the design of an ideal wound dressingalmost impossible. To date, all wound dressings are a compromise, suchthat none offers all of the much desired characteristics in one product.For this reason, there are numerous different wound dressings on themarket, and the typical nurse caring for patients with wounds needingprofessional care will select different dressings for different woundsand for wounds at different phases of the wound healing process.Manufacturers are constantly seeking new ways to make more effectivewound dressings, which means that they are trying to make dressings thatincorporate more of the characteristics and functions listed above. Withthe achievement of each new benefit, the cause of improved patientwelfare is advanced, as the result of faster healing, reduction of painand improvement in the quality of life. Medical care in general canbenefit from such progress. Although these advanced, “active” dressingsusually cost more, they can reduce the overall time during which a woundneeds attention and reduce the amount of nursing time devoted tofrequent changes of dressing. This drives down the huge cost borne bymodern society in caring for wounds.

Our British Patent Application No. 0313217.2 filed on 9th Jun. 2003 andInternational Application No. PCT/GB2004/002374 filed 4th Jun. 2004disclose a skin dressing comprising a first dressing component carryingoxidoreductase enzyme in dried condition; and a second dressingcomponent carrying a source of water, such that when the first andsecond dressing components are placed in fluid communication with eachother, water migrates from the second component towards die firstcomponent and acts to hydrate enzyme carried by the first component, atleast at the surface of the first component.

In one embodiment, the second dressing component comprises a hydrogelformulated to include the following reagents by weight:

-   -   20% sodium AMPS (2-acrylamido-2-methylpropanesulfonic acid,        sodium salt (Lubrizol, code 2405))    -   0.2% poly ethylene glycol 400 diacrylate (UCB Chemicals)    -   0.01% photoinitiator (1-hydroxycyclohexyl phenyl ketone        (Aldrich))    -   20% glucose (Fisher)    -   0.1% zinc lactate (Sigma)    -   0.05% potassium iodide (Fisher)

To 100% with DI-water.

It has now surprisingly been appreciated that such a hydrogel may toadvantage be used on its own for skin treatment, not necessarily incombination with a first dressing component as disclosed in our earlierapplications.

SUMMARY OF THE INVENTION

In one aspect the present invention provides a skin dressing comprisinga hydrated hydrogel material comprising a source of lactate ions and asupply of glucose.

In a further aspect, the invention provides a skin dressing comprising ahydrated hydrogel material comprising a source of lactate ions and asupply of glucose, excluding a hydrated hydrogel comprising thefollowing reagents by weight: 20% sodium AMPS(2-acrylamido-2-methylpropanesulfonic acid, sodium salt (Lubrizol, code2405)), 0.2% poly ethylene glycol 400 diacrylate (UCB Chemicals), 0.01%photoinitiator (1-hydroxycyclohexyl phenyl ketone (Aldrich)), 20%glucose (Fisher), 0.1% zinc lactate (Sigma), 0.05% potassium iodide(Fisher) and to 100% with DI-water.

In another aspect, the invention provides a skin dressing comprising ahydrated hydrogel material comprising a source of lactate ions and asupply of glucose, wherein the glucose is present in an amount of lessthan 20% by weight of the weight of the hydrated hydrogel material.

A hydrated hydrogel means one or more water-based or aqueous gels, inhydrated form.

A hydrated hydrogel can act to absorb water and other materials exudedfrom a wound site, enabling the dressing to perform a valuable anduseful function by removing such materials from a wound site. Thehydrated hydrogel also provides a source of moisture, that can act inuse to maintain a wound site moist, aiding healing.

The hydrated hydrogel conveniently comprises hydrophilic polymermaterial. Suitable hydrophilic polymer materials include polyacrylatesand methacrylates, e.g. as supplied by First Water Ltd in the form ofproprietary hydrogels, including poly 2-acrylamido-2-methylpropanesulphonic acid (polyAMPS) or salts thereof (e.g. as described in WO01/96422), polysaccharides e.g. polysaccharide gums particularly xanthangum (e.g. available under the Trade Mark Keltrol), various sugars,polycarboxylic acids (e.g. available under the Trade Mark Gantrez AN-169BF from ISP Europe), poly(methyl vinyl ether co-maleic anhydride) (e.g.available under the Trade Mark Gantrez AN 139, having a molecular weightin the range 20,000 to 40,000), polyvinyl pyrrolidone (e.g. in the formof commercially available grades known as PVP K-30 and PVP K-90),polyethylene oxide (e.g. available under the Trade Mark Polyox WSR-301),polyvinyl alcohol (e.g. available under the Trade Mark Elvanol),cross-linked polyacrylic polymer (e.g. available under the Trade MarkCarbopol EZ-1), celluloses and modified celluloses includinghydroxypropyl cellulose (e.g. available under the Trade Mark KlucelEEF), sodium carboxymethyl cellulose (e.g. available under the TradeMark Cellulose Gum 7LF) and hydroxyethyl cellulose (e.g. available underthe Trade Mark Natrosol 250 LR).

Mixtures of hydrophilic polymer materials may be used in a gel.

In a hydrated hydrogel of hydrophilic polymer material, the hydrophilicpolymer material is desirably present at a concentration of at least 1%,preferably at least 2%, more preferably at least 5%, yet more preferablyat least 10%, or at least 20%, desirably at least 25% and even moredesirably at least 30% by weight based on the total weight of the gel.Even higher amounts, up to about 40% by weight based on the total weightof the gel, may be used.

Good results have been obtained with use of a hydrated hydrogel of polyAMPS or salts thereof in an amount of about 30% by weight of the totalweight of the gel.

By using a gel comprising a relatively high concentration (at least 2%by weight) of hydrophilic polymer material, the gel can functionparticularly effectively to take up water in use of the dressing, e.g.from serum exudates while in contact with a wound. Because the gel is anaqueous system, use of the dressing does not have the effect of inducingan overall dryness of the wound which would be undesirable. This isbecause water vapour pressure is maintained in the enclosed environmentsurrounding the skin in use of the dressing. The gel thus functions asan absorbent entity for the removal of moisture, e.g. wound exudate,that also provides a helpful background level of excess moisture.

The water-uptake capacity of a hydrated hydrogel, including a highconcentration gel, enables the dressing to aid wound healing by removingsubstantial amounts of exudates, swelling-up as it does so. By using acarefully formulated, ready-hydrated gel, the wound is prevented fromreaching a state of unhelpful dryness. Ready hydration also ensures thequick formation of an aqueous liquid interface between the dressing andthe wound, thus preventing adhesion, which otherwise would interferewith easy lifting of the dressing when it has to be replaced. A goodaqueous liquid interface between the wound and the dressing is alsoimportant in allowing any beneficial products carried in the gel toenter the wound through all of the available surface.

The hydrated hydrogel material is typically in the form of a solidlayer, sheet or film of material that is typically cross-linked, andthat may incorporate a mechanical reinforcing structure. The size andshape of the layer, sheet or film can be selected to suit the intendeduse of the dressing. Thicknesses in the range 0.01 to 1.0 mm, preferably0.05 to 0.5 mm are particularly suitable.

Alternatively, the hydrated hydrogel may be in the form of an amorphousgel not having a fixed form or shape, that can be deformed and shaped inthree dimensions, including being squeezed through a nozzle. Amorphousgels are typically not cross-linked or have low levels of cross-linking.A shear-thinning amorphous gel may be used. Such a gel is liquid whensubjected to shear stress (e.g. when being poured or squeezed through anozzle) but set when static. Thus the gel may be in the form of apourable or squeezable component that may be dispensed, e.g. from acompressible tube or a syringe-like dispenser, comprising a piston andcylinder, typically with a nozzle of about 3 mm diameter. Such a gel maybe applied in the form of a surface layer, or into a wound cavity as afully conformable gel that fills the available space and contacts thewound surface.

A typical example of an amorphous gel formulation is: 15% w/w AMPS(sodium salt), 5% w/w glucose, 0.05% w/w potassium iodide, 0.1% zinclactate, 0.19% polyethylene glycol diacrylate and 0.01%hydroxycyclohexyl phenyl ketone, with the volume made up to 100% withanalytical grade DI water. The reagents are thoroughly mixed anddissolved, then polymerised for between 30-60 seconds, using a UV-A lampdelivering approximately 100 mW/cm², to form the required hydrogel. Thismay be contained in plastic syringes from which the amorphous gel maythen be dispensed from a syringe to a target site, as a surface layer orto fill a cavity.

The source of lactate ions may be any compound capable of releasinglactate ions or lactate-containing ions in water. The lactate ion(derived from lactic acid) is optically active and so may exist in twoenantiomeric forms, L- and D-, and as a mixture of both enantiomers,known as a racemate. Any enantiomeric form, or any mixture ofenantiomeric forms, is suitable for use herein. Convenient sources oflactate ions include sodium L-lactate, sodium D-lactate, sodium D,L-lactate and zinc L-lactate, although it is believed that any solublelactate can be used as a source of lactate ions.

The lactate ions function as a pH buffering substance and as ananti-oxidant. Lactate ions are also believed to have an important rolein creating an environment that stimulates or supports angiogenesis, thegrowth and regeneration of new blood vessels, as well as optimising theredox environment for cellular interaction. There may also be otherbeneficial effects of lactate in the wound environment, but these arenot yet fully understood.

The lactate ions are suitably present in an amount of about 0.1% w/v.

The dressing desirably also includes a source of zinc ions. The sourceof zinc ions may be any compound capable of releasing zinc ions orzinc-containing ions in water. Suitable sources of zinc ions include,for example, zinc lactate, zinc chloride, zinc fluoride, and zincsulphate.

The function of the zinc ions is as an anti-oxidant and as a generalhealing and skin benefit agent, with well-known soothing andanti-inflammatory effects. Zinc is an essential nutritional traceelement which has numerous functions in the growth and repair of healthytissues. In addition, zinc ions are known to form stabilising complexeswith hydrogen peroxide, thus aiding delivery of hydrogen peroxide to thetarget site in embodiments discussed below involving hydrogen peroxide.

The zinc ions are suitably present in an amount of about 0.1% w/v.

A currently preferred source of zinc ions and lactate ions is zinclactate, particularly zinc L-lactate.

The glucose functions to support the biosynthesis of glucose-containingtissue matrix polymers, such as hyaluronic acid, and as an energy sourcefor metabolically active cells, with beneficial effects on woundhealing.

The glucose is suitably present in an amount of at least 2.5%,preferably at least 5% by weight of the weight of the hydrated hydrogelmaterial, with higher amounts also being possible. Good results havebeen obtained with a dressing including 5% by weight of glucose.

The dressing optionally includes a source of iodide ions, e.g. potassiumiodide or sodium iodide. Iodide ions can be oxidised to elemental iodinein the presence of a suitable oxidising agent. Iodine is a knownpowerful antimicrobial agent with beneficial effects on skin, e.g. asdisclosed in WO 01/28600 and WO 03/090800.

The iodide ions are suitably present in an amount in the range 0.05% to0.2% w/v.

The skin dressing of the invention may be used on its own, being locatedon the skin of a human or animal, e.g. over a wound or on a region ofskin to be treated for cosmetic or therapeutic purposes, e.g. fortreatment of acne or other skin conditions. The lactate ions, glucoseand optional zinc ions are observed to have beneficial effects on skinand wound healing.

Alternatively, the skin dressing or the invention may be used incombination with a source of oxygen or an oxidising agent, such ashydrogen peroxide. For example, the dressing may be used in combinationwith superposed material that generates hydrogen peroxide, such as layercomprising oxidoreductase enzyme. The oxidoreductase enzyme may be indry condition, e.g. as disclosed in PCT/GB2004/002374, but is preferablyin hydrated condition, e.g. as disclosed in WO 03/090800 and EuropeanPatent Application No. 04250508.1 filed 30th Jan. 2004, preferably beingincluded in a hydrated hydrogel, e.g. of materials as discussed above.The oxidoreductase enzyme catalyses reaction of an appropriate substratewith oxygen to produce hydrogen peroxide. Suitable oxidoreductaseenzymes are listed in WO 03/090800. The currently preferredoxidoreductase enzyme is glucose oxidase, with the correspondingsubstrate being glucose. Thus, the glucose in the dressing of theinvention acts as a substrate in this case for generation of hydrogenperoxide.

In another embodiment, the superposed layer may contain a supply ofpre-formed hydrogen peroxide, or a hydrogen peroxide precursorsubstance,

Hydrogen peroxide is a known antimicrobial substance, with manybeneficial properties. Where the dressing of the invention includesiodide ions, hydrogen peroxide reacts with iodide ions to generatemolecular iodine, which also has beneficial effects on skin. Inaddition, the rapid decomposition of hydrogen peroxide in contact withtissues and tissue-fluids results in the release of oxygen which isavailable to help in the healing process and acts against anaerobicbacteria that may be present.

In a preferred aspect, the invention thus provides a skin dressingcomprising a first hydrated hydrogel material including a source oflactate ions and a supply of glucose with optional sources of zinc ionsand iodide ions; as discussed above, and a second hydrated hydrogelmaterial comprising an oxidoreductase enzyme. The two hydrated hydrogelmaterials are preferably in the form of layers, sheets or films. The twohydrated hydrogels preferably comprise poly AMPS or salts thereof,desirably in an amount of about 30% by weight of the total weight of thehydrated hydrogels.

In this case the skin dressing is used by being located on the skin of ahuman or animal, as discussed above, with a superimposed hydratedhydrogel material comprising an oxidoreductase enzyme being locatedthereon. As well as the beneficial skin effects arising from the lowerskin-contacting layer, beneficial effects also arise from generation ofhydrogen peroxide and possibly also iodine.

The skin dressing of the invention may also be formulated or constructedin such a way as to control or regulate the rate of diffusion (and hencethe effective dose) of hydrogen peroxide, e.g. by means of limitedavailable water, by an abundance of hydrogen bonding groups in the gelstructure, or by limiting the cross-sectional area of the wound-facingsurface of the gel by the incorporation of a scrim that acts as apartial barrier.

The dressing conveniently includes, or is used with, a covering or outerlayer for adhering the dressing to the skin of a human or animal subjectin known manner.

The skin dressing (or components thereof) is desirably supplied insterile, sealed, water-impervious packages, e.g. laminated aluminiumfoil packages.

EXAMPLE 1

The following composition is a skin treatment product of the form shownin FIG. 6 of WO 03/090800, which comprises a glucose-containing hydrogelslab in accordance with the invention as a lower layer of the product,and an optional additional upper layer comprising a poly-AMPS hydrogelthat incorporates glucose oxidase.

The hydrogel lower layer in accordance with the invention was formulatedto include the following ingredients by weight: Water (ex Fisher,distilled, de-ionised, analytical grade) 64.7% Sodium AMPS (ex LubrizolAMPS 2405 Monomer) 30.0% Polyethylene glycol diacrylate (PEG400diacrylate, ex UCB 0.19% Chemicals available as Ebecryl 11)1-hydroxycyclohexyl phenyl ketone (a photoinitiator, 0.01% ex. Aldrich)Anhydrous glucose (enzyme substrate, ex Fisher) 5.00% Potassium iodide(ex Fisher) 0.05% Zinc L-lactate hydrate (ex Aldrich) 0.10%

The mixture was dispensed into casting trays containing either polyesterscrim (polyester non-woven, open mesh support, available from HDKIndustries Inc, Product Code 5722) or polyethylene net support, ofdimensions 100 mm×100 mm, to a depth of about 1.5 mm. The polyethylenenet support was fabricated from polyester staple fibres thermally bondedby a polyester resin—Product code 5722, from Castle Industries,Greenville, S.C. 9609, USA. The hydrogel was then set, by irradiationunder a UV lamp, for up to 60 seconds and a power rating ofapproximately 100 mW/cm². The hydrogel was then allowed to cool to 30°C. or below.

The enzyme-containing hydrogel was formulated to include the followingingredients by weight: Water (ex Fisher, distilled, de-ionised,analytical grade)  68.6% Sodium AMPS (ex Lubrizol AMPS 2405 Monomer) 15.0% Ammonium AMPS (ex Lubrizol AMPS 2411 Monomer)  15.0% Polyethyleneglycol diacrylate (PEG400 diacrylate, ex UCB  0.19% Chemicals availableas Ebecryl 11) 1-hydroxycyclohexyl phenyl ketone (a photoinitiator, ex 0.01% Aldrich) Glucose oxidase (GOX, Biocatalysts, Pontypridd, 0.035%Code G575P) Zinc L-lactate hydrate (ex Aldrich)  1.0% Pluronic P65(block co-polymer of ethylene oxide and propylene  0.15% oxide,HO—[CH2CH2O]x—[CH2CHCH3O]y—[CH2CH2O]y—H, average MW 3400 (BASF)

The mixture was dispensed into casting trays containing polyester scrim(polyester non-woven, open mesh support, available from HDK IndustriesInc, Product Code 5722) of dimensions 100 mm×100 mm, to a depth of about1.0 mm. The hydrogel was then set, by irradiation under a UV lamp, forup to 30 seconds (typically 25 seconds), and a power rating ofapproximately 100 mW/cm². The hydrogel was then allowed to cool to 30°C. or below.

The resulting gel layers were packaged separately in pouches orenclosures impermeable to water or water-vapour, e.g. made of laminatedaluminium foil pouches as supplied by Sigma (code Z183407).

In use, e.g. on a wound, the wound contact layer can be used on its ownto provide beneficial effects on a wound environment. Alternatively, theenzyme-containing hydrogel and the glucosecontaining hydrogel can bebrought together on a wound surface, one overlying the other.

An oxygen-permeable and moisture-permeable covering or overlay such asof polyutrethane may be located over the enzyme-containing hydrogel andmay be adhered to the skin by means of e.g. acrylic adhesive provided onthe lower face of the overlay.

1. A skin dressing comprising a hydrated hydrogel material comprising asource of lactate ions and a supply of glucose.
 2. A skin dressingcomprising a hydrated hydrogel material comprising a source of lactateions and a supply of glucose, excluding a hydrated hydrogel comprisingthe following reagents by weight: 20% sodium AMPS(2-acrylamido-2-methylpropanesulfonic acid, sodium salt (Lubrizol, code2405), 0.2% poly ethylene glycol 400 diacrylate (UCB Chemicals), 0.01%photoinitiator (1-hydroxycyclohexyl phenyl ketone (Aldrich)), 20%glucose (Fisher), 0.1% zinc lactate (Sigma), 0.05% potassium iodide(Fisher) and to 100% with DI-water.
 3. A skin dressing comprising ahydrated hydrogel material comprising a source of lactate ions and asupply of glucose, wherein the glucose is present in an amount of lessthan 20% by weight of the weight of the hydrated hydrogel material.
 4. Askin dressing according to claim 1, 2 or 3, wherein the hydratedhydrogel material is in the form of a layer, sheet or film of material.5. A skin dressing according to claim 1, 2 or 3, wherein the hydratedhydrogel material is in amorphous form.
 6. A skin dressing according toclaim 1, wherein the hydrated hydrogel comprises hydrophilic polymermaterial.
 7. A skin dressing according to claim 6, wherein thehydrophilic polymer material is selected from polyacrylates andmethacrylates.
 8. A skin dressing according to claim 7, wherein thehydrophiphilic polymer material comprises poly2-acrylamido-2-methylpropane sulphonic acid (poly AMPS) or saltsthereof.
 9. A skin dressing according to claim 6, 7 or 8, wherein thehydrophilic polymer material is present at a concentration of at least1%, preferably at least 2%, more preferably at least 5%, yet morepreferably at least 10%, or at least 20%, desirably at least 25% andeven more desirably at least 30% by weight based on the total weight ofthe gel.
 10. A skin dressing according to claim 1, wherein the source oflactate ions is selected from sodium L-lactate, sodium D-lactate, sodiumD, L-lactate and zinc L-lactate.
 11. A skin dressing according to claim1, further comprising a source of zinc ions.
 12. A skin dressingaccording to claim 11, wherein the source of zinc ions is selected fromzinc chloride, zinc fluoride, zinc sulphate and zinc lactate,particularly zinc L-lactate.
 13. A skin dressing according to claim 1,wherein the glucose is present in an amount of at least 2.5%, preferablyat least 5%, by weight of the weight of the hydrated hydrogel material.14. A skin dressing according to claim 1, further comprising a source ofiodide ions, e.g. potassium iodide or sodium iodide.
 15. A skin dressingaccording to claim 1, in combination with a source of oxygen or anoxidising agent.
 16. A skin dressing according to claim 15, incombination with material comprising oxidoreductase enzyme, preferablyglucose oxidase.
 17. A skin dressing according to claim 16, wherein thelayer of material comprising oxidoreductase enzyme comprises a hydratedhydrogel.
 18. A skin dressing comprising a first hydrated hydrogelmaterial comprising a source of lactate ions and a supply of glucosewith optional sources of zinc ions and iodide ions; and a secondhydrated hydrogel material comprising an oxidoreductase enzyme.